Provider Demographics
NPI:1891029401
Name:HARRISBURG MEDICAL CENTER INC
Entity Type:Organization
Organization Name:HARRISBURG MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-253-7671
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-0428
Mailing Address - Country:US
Mailing Address - Phone:618-253-7671
Mailing Address - Fax:618-252-3763
Practice Address - Street 1:100 DR WARREN TUTTLE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG, SALINE
Practice Address - State:IL
Practice Address - Zip Code:62946-0428
Practice Address - Country:US
Practice Address - Phone:618-253-7671
Practice Address - Fax:618-252-3763
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRISBURG MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-29
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000521273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
615042Medicare Oscar/Certification